ACTION ICU Score for Intensive Care in NSTEMI

ACTION ICU Score for NSTEMI

Age

Heart Rate

Systolic Blood Pressure

Signs of Heart Failure

Prior MI

Elevated Troponin

ST Depression on ECG

Creatinine

ACTION ICU Score: 0

Low Risk

Routine ICU admission unlikely to provide benefit. Consider telemetry or step-down unit.

Predicts risk of NSTEMI complications requiring ICU care.

Why Use

Helps identify patients who are initially stable but may later develop complications requiring a higher level of care, and may therefore help with disposition and avoiding failure to rescue.

When to Use

Emergency patients with NSTEMI, to predict likelihood of complications requiring ICU care for patients with NSTEMI. Should not be used in patients with STEMI, cardiogenic shock, or cardiac arrest.

Formula

0 points 1 point 2 points 3 points 5 points Age, years <70 ≥70 -- -- -- Serum creatinine, mg/dL <1.1 ≥1.1 -- -- -- Heart rate, bpm <85 85-100 -- ≥100 -- Systolic blood pressure, mmHg ≥145 125-145 -- <125 -- Initial troponin, times above upper limit of normal <12 -- ≥12 -- -- Heart failure signs or symptoms No -- -- -- Yes ST depression on EKG No Yes -- -- -- Prior revascularization Yes No -- -- -- Chronic lung disease No -- Yes -- --

Pearls / Pitfalls

Derived in patients ≥65 years old, and may not apply to younger patients. Different institutions may use different thresholds for ICU admission. Not yet prospectively validated.

Management

Hospital systems should define their own threshold for ICU admission, based on ICU capacity, non-ICU resource availability, etc. For example, an ACTION ICU threshold of 5 might triage 50% of patients to the ICU, with an expected complication rate of <10% for non-ICU patients, while an ACTION ICU threshold of 12 might triage 50% of only very high risk patients to the ICU.

Critical Actions

This predictive tool should not replace clinical judgment. Not all factors benefiting from ICU care can be accounted for in this score.

Advice

Patients with low risk for complications requiring ICU care may be considered for admission outside of an ICU setting. Patients with high risk for complications requiring ICU care may benefit from early admission to the ICU.

More Information

Interpretation: ACTION ICU Score Risk of complications requiring ICU care among initially uncomplicated patients with NSTEM I * ≤1 3.4% 2 4.9% 3 5.5% 4 6.9% 5 9.3% 6 12% 7 14.6% 8 17.4% 9 20.8% 10 23.3% 11 27.7% 12 31% 13 31.5% 14 39.3% >14 >39.3% *Cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during index admission.